Icheon Elementary, Middle, and High School Cafeteria Labor Conditions and Health Effects Survey

Korean Institute of Labor Safety and Health

2022

1. Background and methods of the study

School cafeteria workers are responsible for feeding elementary, middle, and high school students across the country. The high number of servings per worker, the incidence of accidents and musculoskeletal diseases, and the recent cases of lung cancer caused by cooking fumes, a carcinogen, have led to a high demand for improvements in the working environment. Since the labor union has been fighting to improve working conditions for a long time, the cafeteria environment and staffing standards have improved. However, the staffing standards in school cafeterias are higher than those of other public cafeterias, and the labor intensity is still high, so further improvement is urgently needed.

In addition, due to changes in the number of students going back to school after COVID-19, workers’ workloads have changed and additional tasks have been added, increasing labor intensity. As such, we wanted to understand the changes in the working environment and the impacts on workers’ health in school cafeterias after COVID-19.

For workers who must work even if they are sick, the necessary measures are to improve the deployment standards and expand the number of replacement workers. We wanted to examine what solutions could be found in the city of Icheon. Similarly, by investigating the working environment of school cafeterias, which is the cause of diseases and accidents, and the health effects on workers, we aimed to identify the intensity of labor in school cafeterias in Icheon and find ways to work healthily.

2. Survey results

We surveyed 151 school cafeteria workers in Icheon. All 151 were women, with the majority in their 50s. The surveyed workers included both chefs and cooking assistants. The average number of people served per worker was 102. 

In the survey, 55% of respondents reported no meal breaks and 61% reported no rest breaks. The average meal break is 18 minutes, which means that even when meal breaks are provided, they must be quick. And in the case of breaks, it is hard to see how they can be considered adequate if they are provided at the end of the workday, just before leaving the office. 

When asked about food odors and steam generation due to high temperatures, humid environments, and inadequate ventilation, 80-90% of the respondents reported being exposed to them for more than a quarter of their working hours. It is necessary to check whether the location and number of ventilation fans in the cafeteria are appropriate. It is recommended to be especially careful about cooking fumes, which are known to occur frequently during frying.

We asked cafeteria workers about the stress they have experienced due to COVID-19, including changes in job demands and relationship conflicts in the workplace. In the survey, 83% of respondents said that since the outbreak of COVID-19, they work more than before, are always pressed for time, and have fewer breaks than before. Approximately 83% of respondents said they have to multitask more than before, and 82% said their workload has increased.

When looking at the prevalence of musculoskeletal symptoms by body part according to the NIOSH criteria, 84% of the participants met the criteria. In particular, we found that the higher the served number of people per capita, the more severe the musculoskeletal symptoms. In some cases, if fewer workers are employed, but the area of the cafeteria or kitchen has not been reduced in relation to its smaller workforce, there is a possibility of higher musculoskeletal loads for cleaning. 

The average value of the Borg Index, a subjective measure of labor intensity, which asks people to indicate how tired they are on a scale of 6 to 20, was 14. This corresponds to a brisk walking level of exertion of 13-14. When asked how much they would need to reduce their work intensity from their current level to avoid experiencing severe fatigue, respondents said they would need to reduce it by approximately 35%.

When asked if they had been treated at a hospital in the past year for a work accident or musculoskeletal disorder, 39 (33%) respondents said they had been treated at a hospital for a work accident, and 87 (74%) said they had been treated for a musculoskeletal disorder. However, most of them paid for the treatment themselves.

3. Interview results

We interviewed a total of nine workers with between five and 23 years of work experience in school cafeterias. In-depth interviews were conducted to understand their perceptions of labor intensity and workload, and their experiences with workplace accidents and illnesses. We asked the workers to share their perceptions of the factors that contribute to the intensity of labor in Icheon elementary, middle, and high school cafeterias, as well as their assessments of work environment issues such as equipment, tools, and work methods. 

Interviews with school cafeteria workers in Icheon confirmed the high labor intensity of cooking and serving large quantities of food, washing dishes, and cleaning. In the cafeteria, where as few as three and as many as 10 workers work hand in hand, they work at a fast pace with no breaks. Workers are doing more work than one person can do, therefore, they are unable to ask their coworkers for help in lifting heavy objects to avoid injuring themselves.

School cafeterias involve a lot of repetitive tasks like knife work, heavy lifting, squatting and stooping to clean, and other physically demanding activities. In addition, the high heat of frying or stir-frying foods and the burden of washing dishes afterward make it even more difficult for workers. Washing dishes is one of the most difficult tasks, with the heat and noise from the dishwasher and the pain in the fingers that comes from separating trays and removing food before washing. We found that this high labor intensity does not diminish with more experience. 

It is not easy to take a break from work in a fast-paced cafeteria. After a fast-paced morning, the first time they can sit down is during a meal after they finish cooking, which they said took between 10 and 20 minutes. In many schools, breaks to reduce fatigue are taken at the end of the day, not in the middle. This is because it is more important to finish work quickly than to take a break.

Since 2020, when the COVID-19 pandemic began, there have been a lot of additional problems. In 2020 and 2021, when students did not go to school or went part-time, some of the workload was reduced, but there were additional tasks such as sanitizing. Furthermore, in early 2022, when COVID-19 was spreading rapidly, half of the coworkers did not show up for work, forcing the remaining workers to endure a double workload for several days. The burden was shifted to the workers without any alternative arrangements during a global disaster.

Our interviewees suffered from musculoskeletal disorders throughout their bodies and had experienced slips, falls, burns, and cuts. Many of them had received medical treatment for their accidents and illnesses, but most had either continued to work or paid for their own medical bills. The workers knew about workers’ compensation, but they did not think they were sick or injured enough to file a claim. They thought they could file for workers’ compensation in the event of a serious accident. 

Insufficient staffing was cited as top priority for improvement due to its significant contribution to high labor intensity. It is also very difficult for workers to find a replacement for themselves when they need to take a vacation or take sick leave. Therefore, most of them have experienced coming to work even when they are sick, because they feel bad about adding to the burden of their coworkers. This situation can lead to health problems in workers and needs to be addressed. The workers said that they had already given up on improving the staffing standards because it is a matter for the school board. The fundamental improvement of the staffing standards along with the improvement of the system to provide substitute workers is necessary to create a school cafeteria where workers’ health is guaranteed.

4. Fieldwork results

While the risk of safety incidents has decreased as a result of modernizing cafeterias, weaknesses in health management, such as musculoskeletal strain from cafeteria work, still exist. 

Improvements such as adjustable countertop heights to fit the worker, rather than the worker fitting the countertop, or allowing the worker to lean back or put their feet up during prepping, cooking, and cleaning, which normally require prolonged standing, could alleviate some of the strain. 

The burden of standing during the distribution process can be alleviated by allowing workers to sit down or by providing standing chairs. In addition, it is likely that improvements in working conditions can be derived by actively reflecting opinions from workers, such as using pre-treated ingredients to ease the burden of chopping ingredients.

Although we only conducted fieldwork in three schools, it was clear throughout the fieldwork process that the labor intensity of food service workers was considerable. The labor intensity includes:

• The burden of heavy lifting, such as carrying considerable amounts of plates and cutlery by themselves;
• Cleaning the hall (dining area) which requires them to move all the chairs on top of the table and lower them after the floor is cleaned; and 
• Pushing, pulling, and moving food carts filled with food for classroom distribution by themselves. 

All these tasks are hard on the workers’ bodies. It is a fact that these workloads are caused by the labor shortage. 

\There are many other factors that can make food service workers sick in schools. As mentioned earlier, it is necessary to monitor the working environment including noise, cooking fumes, and high temperature to understand the actual situation in detail. As the field survey of only three schools showed that the conditions of each school cafeteria are very different, it is necessary to conduct a detailed inspection and improve the working environment and preventive health management through a nationwide survey. At the same time, efforts should be made to alleviate job stress and prevent workplace bullying arising from the hierarchical structure of the cafeteria and high workload. 

In schools where modernization of the cafeteria was promoted, the overall working environment was improved, and the risk of accidents was significantly reduced. However, despite the improvement of the working environment, the intensity of labor, such as “running” and “no time to breathe,” inevitably increases the possibility of accidents. In the end, it is important for all parties to recognize that without efforts to reduce labor intensity, it is difficult to prevent safety accidents and ensure a healthy cooking environment for workers. Based on this consensus, a cafeteria-friendly working environment for older women workers should be organized. 

5. Conclusion and Recommendations

While significant improvements have been made to food service kitchens which has reduced the risk of accidents, musculoskeletal disorders are still prevalent, as are respiratory illnesses and work stress. It is time to shift the focus from safety to health. To prevent the musculoskeletal disorders that food service workers face on a daily basis, it is essential to reduce overall labor intensity and ensure adequate staffing levels. Ergonomic improvements such as adjusting countertop heights and providing standing chairs can also help. Preventing accidents and illnesses is of utmost importance, but when they do occur, workers are not yet aware that it is their right to file a workers’ compensation claim. Awareness needs to be raised.

High labor intensity in school meal preparation has been a long-standing problem. In Icheon, cafeteria workers experienced high rates of musculoskeletal symptoms and inability to take time off from work. Increased work demands after COVID-19 have been confirmed. The labor intensity of “running” workers increases the risk of illness and accidents. Active measures are needed by cities and provinces, such as relaxing staffing standards and supporting alternative labor systems.

Listening to workers’ voices is crucial to making these improvements. Therefore, in individual schools, food workers, nutritionists, vice principals, and principals should work together to improve conditions through democratic communication. Although there is no legal obligation or authority at the education support agency level, it is possible to improve safety and health issues by operating a safety and health committee with workers. The city-level Icheon Education Support Agency needs the support of the provincial-level Gyeonggi-do Office of Education, but the Icheon Agency can play a role by preparing complementary measures in areas related to substitute workers, operating a local-level occupational health and safety consultation body, and supporting schools with particularly high labor intensity, for example by implementing a system that increases the number of students that eat in a centralized dining area instead of delivering food to each classroom.